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1、上海星达保险经纪有限公司地址：上海浦东新区东方路989号中达广场1002A室 电话：（021）6876 3600 传真：（021） 6876 7730INSURANCE RISK EXPOSUREQUESTIONAIRE 保险风险调查表上海星达保险经纪有限公司UNISTAR INSURANCE BROKERAGE & CONSULTING (SH) LTD. INSURANCE QUESTIONNAIREThis form has been completed by 填表人 _Position 职务 _ Company 公司 _ Telephone No. 电话 _Currency: Valu
2、es shown in this Questionnaire shall be in RMB.币种: 本问卷中所填金额的币种为人民币。Declaration声明We hereby declare that the information provided in this questionnaire is true and complete to the best of our knowledge. We agree that this questionnaire shall be the basis of the insurance contract between us and the in
3、surer.我们在此声明本问卷中提供的信息系我们所知的真实、完整的情况。我们同意本问卷成为保险人与我们之间达成保险合同的基础。Date日期_ Signature签名 _Please return this form completed TO:请填写该调查问卷并发至：Account Manager & Email AddressInsurance Broker: UNISTAR Insurance Brokerage & Consulting (Shanghai) Ltd. 上海星达保险经纪有限公司Address of Broker: 上海浦东新区东方路989号中达广场1002A室 TELEPH
4、ONE NO: 021-68762600*666FACSIMILE NO: 021-68767730IMPORTANT NOTICE CONCERNING DISCLOSURE 告知义务It is your duty to disclose all material facts to underwriters. A material fact is one which may influence an underwriters judgement in his consideration of your risk as to whether to provide insurance and o
5、n what terms. It is likely that any change in facts previously advised will be material and such changes should therefore be notified.您有责任将所有重要事实告知保险公司。所谓重要事实是指任何足以影响保险公司作出是否承保风险以及以何种条件承保风险的信息。如已告知的重要事实发生变化，您仍需要将该变化通知保险公司。This duty places a responsibility on you to disclose all material facts. The q
6、uestions in this questionnaire provide a helpful way of enquiry, but should not be taken as limiting the duty of disclosure. If you are in any doubt as to whether a fact is material you should disclose it.这一义务赋于您告知所有重要事实的责任。该调查问卷只是帮助询问重要事实，这并不意味您的告知义务仅限于此。如果您无法确定某一事实是否属于重要事实，请将该事实告知我们。FAILURE TO DIS
7、CLOSE could prejudice your right to recovery in the event of a claim or allow underwriters to avoid the policy from its inception.未履行告知义务会影响您的索赔权利或使保险公司有权自保单生效之日起取消保单。Appropriate enquiries should be made to ensure that the answers set forth herein are true and complete and that no material fact has
8、been omitted. Any change in the answers given and any material change in the risk arising before inception of your policy must be advised to us and should therefore be notified immediately.在填写调查问卷时，应保证答案是正确完整的，重要事实没有被忽略。在保单正式生效前，如已填写的有关情况发生变化或有关风险的重要事实发生变化，请立即通知我们。UNDERINSURANCE 不足额保险Many policies c
9、ontain a Co-insurance (or Average) provision whereby you may be required to bear a rateable proportion of the loss in the event that the sum insured is less than the value of the insured property at the commencement of the insurance.大多数保单都包括共保（或比例分摊）条款，该条款规定，如果保险金额小于保单生效时的保险财产的价值，您需承担一定比例的损失。UTMOST
10、GOOD FAITH 最大诚信原则Every contract of insurance is based on “Utmost good faith” which requires each party (i.e. you and the insurer) to act towards the other party in respect of any matter arising under the contract, with the utmost good faith. If you fail to do so you may prejudice any claim.每一份保险合同都是
11、建立在最大诚信原则的基础上，这一原则要求合同双方（您和保险公司）在保险合同下的任何行为都应遵循最大诚信原则。如果您没有遵循该原则，这将会影响您的索赔权利。GENERAL INFORMATION4基本情况INSURANCE POLICY INFORMATION4现有保险基本情况企业基本风险保障PROPERTY DAMAGE INSURANCE6财产一切险PROPERTY EXPOSURE DATA10财产保险风险数据BUSINESS INTERRUPTION INSURANCE13利润损失保险BUSINESS INTERRUPTION WORKSHEET16营业中断保险表格(Gross Prof
12、it Form)16BUSINESS INTERRUPTION WORKSHEET19营业中断保险表格(Gross Earnings Form)19MACHINERY BREAKDOWN & MACHINERY BREAKDOWN BUSINESS INTERRUPTION INSURANCE24机损险及机损险营业中断保险MONEY INSURANCE27现金保险OPEN MARINE CARGO INSURANCE30货物运输开口保单INLAND TRANSIT INSURANCE35内陆运输保险EMPLOYERS LIABILITY INSURANCE38雇主责任保险PUBLIC LIAB
13、ILITY INSURANCE39公众责任保险PRODUCTS LIABILITY INSURANCE43产品责任保险FIDELITY GUARANTEE INSURANCE50雇员忠诚保险企业员工福利保险风险保障EMPLOYEE BENEFIT INSURANCE 员工福利保险企业员特殊保险风险保障DIRCTORS & OFFICIALS LIABILITY INSURANCE董事及高级管理人员责任保险TRADE CREDIT INSURANCE信用保险保险CONSTRUCTION / ERECTION ALL RISKS INSURANCE58建筑及安装工程一切险GENERAL INFOR
14、MATION基 本 情 况1. The current Named Insured in terms of your major policies is as follow:目前，贵司保单中的列明被保险人是: 2.List ALL business activities, please provide particular details of any part of the business, where design or advice is provided to customers in the absence of sale or supply of products/services.请列明贵公司所有的营业活动，如贵公司并不是销售产品或提供服务，只是向客户提供设计或专家建议，请提供该营业活动的详情。
